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Texas rates for HCPCS L1904

Ankle orthosis (AO), ankle gauntlet or similar, with or without joints, custom fabricated

Facilitymedian $417 · 10th–90th $234–$2,6920%10%10th90th$417Professionalmedian $257 · 10th–90th $234–$3800%20%10th90th$257$0.5$2.0$10.0$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$234.42 / $234.42 / $245.47
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $257.04 / $380.19
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,162.28 / $3,388.44 / $4,168.69
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $251.19 / $251.19
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $537.03 / $537.03
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $338.84
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $331.13
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,818.38 / $2,818.38 / $2,818.38
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,073.80 / $4,073.80 / $4,073.80
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$234.42 / $426.58 / $758.58
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $257.04 / $512.86
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $295.12 / $302.00
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $323.59 / $1,995.26
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $407.38 / $758.58
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $331.13
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $371.54 / $616.60
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $316.23 / $380.19
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $537.03 / $537.03